Azealia Banks is a star!

Girl has ar-rived.

LOUD and CLEAR

Child Abuse. Rape. Male domination and violence against women, children, the powerless. This shit has been going on for centuries.
Finally, finally it is surfacing like a breaching whale. On video.
Sick brutal behavior being called out.
LOUD and CLEAR

The Cost of Cosmopolitan Living

Mayor of London Boris Johnson is refusing to pay a U.S. tax bill. Turns out Johnson holds dual UK/US citizenship having been born in New York, and therefore is required to file U.S. tax returns. The IRS is demanding he pay capital gains tax on the sale of his primary residence in London, because the UK does not tax capital gains on the sale of first residences.

I’m no fan of Boris, yet another elite who is out of touch and/or uncaring about most people’s lives, but in this case he does have a point.

It iis< "very difficult" to give up U.S. citizenship, as he claims (multiple forms, fees and in-person pass/fail interviews with consular officials). And through no fault of his own he was born a U.S. citizen because his parents flitted between countries on socio-financial whims.

So he can blame Mummy and Daddy for his predicament. Or the over-encompassing new law (FATCA) intended to prevent American tax evaders from hiding money overseas, but which now affects every U.S. citizen living abroad.

Life is not always fair. Sometimes it takes considerable effort to deal with injustice while maintaining some measure of integrity. Rarely there are nightmare stories where lives are practically ruined by injustice, though one might think it is more common because the press gravitates towards these tragic stories – or questionably propagates them – as did the recent Guardian headline for an article about FATCA – "I was terrified we'd lose all our money."

Heaven forbid Bombastic Boris would ever come out and acknowledge his true place in all of this.

Hope is Dead. Long Live Hope.

I just drove past where my friend Hope died in 2002. We met in rehab in 1998 when I was 36 and she was 38. When she died she was 53. I never had the chance to ask her, but she probably chose that age so we would have one more thing to bond over in rehab.

Her car veered off the freeway into a tree. We didn’t know if it was suicide or accident. Nor if she was extra-opiated. Her conservative Catholic parents would not acknowledge the truth. We did know, as only fellow deep sufferers can, how sad and unhappy she was. Mercifully that ended. Hope Dominguez was a lovely, considerate and deeply thoughtful person. She lives on in those of us who knew and cared about her.

Knowledge is….

Power to the People!

Just made my donation to Wikimedia.

The Future of Healthcare

Imagine a time…

…when consumers can use instant comparison shopping for health insurance, medical procedures and medications – much like they can now with internet price comparisons and consumer reviews for hotels, travel fares and home electronics.

…when patients can quickly compare scientifically proven results for different types of treatments and medications.

…when doctors can make “house calls” using video technology and home medical devices.
This is the future of healthcare – a future made possible by the “other” revolution in healthcare.

While mandatory health insurance and the specter of ObamaCare have gotten the lion’s share of political and media attention, passing almost unnoticed are changes which will substantially affect how healthcare is delivered and how costs are determined.
Over the last 20-30 years, the evolution of healthcare has been a strange study in contrasts. On the plus side, medical breakthroughs have occurred so quickly it is hard to keep track of them. Improvements in treating heart disease and cancer, minimally-invasive surgery and improved diagnostics (MRI and other scans), to name just a few. Thanks to healthier lifestyles and improved patient care, more than 50% of babies born today in America will live to 100.

Even though there have been great medical advances over the last few decades, healthcare administration has remained mired in archaic and inefficient practices, including a staggering lack of computerization. The cost of healthcare has spiraled out of control. Americans now spend more than twice as much per capita than any other country, yet many are unable to obtain proper healthcare.

Though much of ObamaCare has been caught up in political maneuvering, one aspect of healthcare reform – computerization – has mostly escaped controversy. Many Americans are surprised that in this day and age healthcare in America is largely not computerized. The most commonly cited reasons are cost, complexity, lack of standardization, and uncertainty about the path forward. The inefficiencies and costs tied to lack of computerization have grown so much that America’s largest healthcare consumer – the U.S. Government by dint of the fact it reimburses hundreds of billions of dollars annually to providers for Medicare and other government-subsidized programs – has decided to stop waiting.

The HITECH Act, part of the American Recovery and Reinvestment Act of 2009, gave impetus and direction for computerization of healthcare across America by earmarking $20 billion to reimburse providers (hospitals, clinics, doctors, etc.) for the one-time cost of computerizing. Additional incentive was given by setting penalties for providers who did not computerize by 2015. Much of the computerization has already taken place, with the rest scheduled for completion by 2015 so that providers can avoid being penalized.

The pace and scope of this undertaking is unprecedented in the history of business. Computerization is not just a matter of installing software. Workflows for patient visits, from scheduling and check-ins, to administering tests and procedures – all must be changed to utilize medical software. And implementing new systems is just the first stage of the revolution.

Once the systems have been in place for a few years, and data banks have had time to grow, clearinghouses will be created for comparisons of treatments and cures, insurance shopping, and other related industries. Medical research and development will explode with the vast amounts of data becoming available.

Government has provided the impetus; the healthcare industry has responded. In this age of internet and mobile devices, it will be consumers who ultimately drive the market.

Interesting times indeed.

State Rights (or Wrongs)

I can’t help but notice that the Trayvon Martin verdict is the second recent major historical event (the other being the gay marriage Supreme Court decisions) where state laws play a significant role.

Florida’s gun laws and culture allowed a technically legal verdict which almost certainly wouldn’t have been delivered in California, Illinois, New York and many other states. Though equal rights for gay marriage now exist in 13 states, such is not the case in the 37 others.

Only in America can such profound legal issues be left up to individual states. It’s almost as if there is no justice for all in America, but justice per micro-republic.

How Well Does Your Electronic Health Record Play With Others?

The long-awaited promise of electronic health records in the Unites States is finally becoming reality.  Most healthcare organizations, if they haven’t yet adopted EHR’s, are well on their way.

The benefits of EHR’s are numerous and profound.  Some benefits will be realized almost immediately – streamlining patient visits, reductions in medical errors and better processing of insurance claims, to name just a few.

Other benefits will soon follow. The vast amount of healthcare data generated by EHR’s will be used  by clinicians to better  diagnose conditions and determine the most effective treatments. This data will also help researchers to discover new cures and treatments. Patients will find a wealth of new medical information on the internet.

One drawback is that the first wave of EHR implementations will result in multiple health records existing for each patient, since healthcare organizations will be maintaining EHR’s only for patient visits within their purview.  At this time, there is no clear path for merging multiple EHR’s into a single record for each patient.  However, there is little doubt that once patients become accustomed to having access to their own EHR’s, they will have the expectation of consolidating their EHR’s into a single Personal Health Record. Doctors and other clinicians will also want to access consolidated EHR’s, instead of scanning between several records brought in from other organizations at the patient’s request.

EHR’s are signed legal documents; therefore, only authorized personnel –  usually physicians – will be able to create or modify them.  Merging separate EHR’s presents legal issues, in addition to technical ones. Patients, unless they are clinicians themselves, will have neither the medical expertise nor legal authority needed to effectively consolidate their medical records.  It logically follows that patients will look to their healthcare providers for help.

Most of the Affordable Care Act takes effect in 2014, and going by the accelerated pace of consumer technological expectations  (smart mobile devices barely existed until a few years ago), meeting the demand for consolidated EHR’s should be an immediate priority for all healthcare organizations.

This woman is 87 years old